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Vasopressin Therapy of Hemorrhagic Complications Following Coronary Artery Bypass Grafting-Reply

Richard C. Becker, MD; Joseph S. Alpert, MD
Arch Intern Med. 1991;151(10):2100. doi:10.1001/archinte.1991.00400100150029.
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In Reply. —  Watson raises an interesting and clinically relevant question concerning the use of 1-desamino-8D-arginine vasopressin (DDAVP) in patients with hemorrhagic disorders and coronary artery disease.Intravenous DDAVP administration increases antihemophilic factor (factor VIII) titers in plasma. Given in a standard dose of 0.3 μg/kg, it also provokes a modest rise in factor VII and factor XII concentrations. These properties may, therefore, be considered procoagulant, favoring normal hemostasis.Coronary arterial and other thrombotic events in patients with hemophilia have typically occurred following the intravenous administration of factor VIII concentrate.1,2 Indeed, the case cited3 describes an elderly man with coronary disease risk factors who experienced a myocardial infarction following peripheral vascular surgery. Beyond the fact that coronary disease is highly prevalent in these patients and myocardial infarction is the leading cause of perioperative morbidity and mortality,4 the patient received factor VIII concentrate in addition to DDAVP, the


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